Existing Care Coordination Programs
Patient-Centered Medical Home: An Overview
“When we were told we would be able to get a Care Coordinator, somebody who could solve all these little problems to prevent bigger problems, we were thrilled.”
—- Denise Mayo, MD Primary Care of Wellesley
Healthcare is too complex for one single provider in the modern day; it needs a team to succeed.
Physicians will now have a team that helps them work with the patient, and understand what the patient needs. The physician now has someone who can facilitate his treatment plan, and the patient has an advocate that helps them navigate in the healthcare system.
Role of the Care Manager
“….I have to discharge someone who is sick, and complicated, and lives alone, and can’t drive to get to his doctor’s appointment. I am reassured by knowing that there is a care manager, who as soon as I discharge them, will be on the other side, waiting to help facilitate their care. ” — Namita Seth Monta, MD
Care coordination in Ontario Canada
A care coordination program in Canada. Unlike other care coordination programs, the care coordinators here pays visit to the patients and report their conditions to care providers.
They transition patients from hospitals and assist them in regaining independence.
This program targets high risk populations in a community setting. Keeping people in their homes, so there is more room in the hospital for people who actually need to be in the hospital. These care coordinators go as far as doing home assessments for the patients. Taking care of what happens after patients are discharged.
Alegent Creighton Clinic’s care coordination program
“We offer care coordinators for patients who receive a chronic illness diagnosis. A care coordinator is a nurse who helps you manage your disease, keeping you on track with medications, diet, and exercise. As your partner, your care coordinator connects you to doctors, specialists and other medical resources like nutritionists, dietitians, and pharmacists. As a result, you’ll have the knowledge to manage your disease.”
The Future of US Healthcare Part II: Care Coordination
the key to sustainable healthcare
“The role of the Care Manager is a new one at many physician practices. The job of the care manager is to think about patient needs other than what is provided right in the office. These can be social services, transportation services, medication reminders–whatever it is that a complex patient might need in order to remove barriers to high quality care, and to landing themselves in the hospital.”